Klavdia Bukina
Adapted Physical Education for Autistic Adolescents
Thesis Kajaani University of Applied Sciences School of Health and Sports Degree Program in Sports and Leisure Management 14.05.2015
ABSTRACT
School Degree Programme
Health and Sports Sports and Leisure Management
Author(s) Klavdia Bukina
Title
Adapted Physical Education for Autistic Adolescents vaihtoehtiset
Optional Professional Studies Supervisor(s)
Coaching Kari Partanen
Commissioned by Väinölä School
Date Total Number of Pages and Appendices
14.05.2015 56 + 14
This thesis studies the physical development and education of 12-17-year-old adolescents with autism spectrum disorder and examines the adapted physical program at Väinölä School. The school is focused on special educa- tion for children and adolescents with a variety of mental and physical disorders, and provides individual educa- tion and other specific services for autistic adolescents. However, no adapted physical education program specif- ically for autistic adolescents is currently utilized in the school.
The main purpose of this thesis is to identify the main deficits in gross motor skills of the autistic individuals at Väinölä School. This thesis aims to determine how to choose proper physical adapted education exercises for autistic adolescents, and to determine if these exercises can improve their motor skills. Also, this thesis introduc- es an adapted physical education program for the autistic adolescents at Väinölä School.
The research data were gathered qualitatively from each participant. First, the participants were observed for 5 months on a weekly basis to surveys their physical activity and capabilities. After the observation period, the physical activity level and capabilities of each participant were evaluated using a specific physical activity tests.
Participants were tested for 5 different gross motor and balance related skills. The physical activity program was made based on the evaluated results from the tests. The final physical activity program included various physical activity exercises for a 6-month period according to participants’ individual physical activity level.
In this study, autistic adolescents were shown to have most severe problems with balance and coordination relat- ed skills. This research highlights the problems of gross motor skill development among autistic adolescents. It was found that at least 5 important gross motor and stability skills, such as: forward and backward walking, bal- ance, coordination and crawling, can be improved by the use of modified APE program, made specifically for the different physical activity levels of the participants.
In conclusion, the autistic adolescents at Väinölä School have incificient motor skills. It was also noted, that dif- ferences in physical activity do not translate as they are into the level of motor skills. Also, an adapted physical education program can be devised in a way that it is suitable for participants with variable skill levels.
Language of Thesis English
Keywords Adapted, adolescents, autistic, education, physical Deposited at Electronic library Theseus
Kajaani University of Applied Sciences Library
PREFACE
I would like to thank all the staff members and students of Väinölä School who participated in research and especially Riikka Huotari, the working life supervisor. Without their help, inspiration and good vibes after each observing session it would have been impossible for me to complete this thesis. Also, I would like to express my deep gratitude to the KUAS staff and my supervisor Kari Partanen for providing great help throughout the research.
I would also like to thank Paavo Halonen for the encouragement, love, exceptional patience and notable help, and KEF Blades for the remarkable atmosphere and support throughout the thesis process.
CONTENTS
1 INTRODUCTION 1!
2 AUTISM DISORDER 4!
2.1 History of Autism 5!
2.2 Types 7!
2.3 Reasons for Autism 10!
2.4 Treatment 12!
3 ADOLESCENTS WITH AUTISM DISORDER 16!
3.1 Emotional and Psychological Development of Autistic Adolescents 16! 3.2 Physical Growth and Motor Development in Adolescence 18! 3.3 Physical Growth and Motor Development of Adolescents with Autism 19!
4 ADAPTED PHYSICAL EDUCATION 22!
4.1 Definition and Nature of APE 22!
4.2 APE for Autistic Adolescents: Ethics and Reliability 23!
4.3 Teaching APE for Autistic Adolescents 24!
4.4 Different Approaches to Providing APE for Autistic Adolescents 26!
5 RESEARCH TASKS 27!
6 RESEARCH METHOD 28!
6.1 Commissioner of the Thesis 28!
6.2 Qualitative Research Method 28!
6.3 Choosing the Proper Research Methods 29!
6.4 Participants 30!
6.5 Instruments 30!
6.5.1 The Testing Protocol 30!
6.5.2 The Testing Scale 31!
6.6 Data Collection and Procedures 33!
6.7 Data Analysis 34!
7 RESULTS 35!
7.1 Observing Period 35!
7.2 Choosing Proper Physical Activity Tasks for Autistic Adolescents 38!
7.3 Pre-Testing 38!
7.4 Adapted Physical Education Program for the Participants 39!
7.5 Post-Testing 41!
7.6 Adapted Physical Education Program 44!
8 DISCUSSION 46!
8.1 Research Evaluation 46!
8.2 Ethicality and Reliability 48!
8.3 Personal Development 49!
8.4 Further Studies 50!
9 CONCLUSIONS 51!
SOURCES 52!
APPENDICES
1 INTRODUCTION
Autism spectrum disorder affected roughly 2% among children 6-17-year-old in 2011–2012, and its prevalence has increased nearly by 100% from 2007, when only 1.17% of the chil- dren with the same age were affected (Blumberg et al. 2013). The prevalence of autism has increased dramatically from the 1980s, partially due to increased diagnostic capabilities (Blumberg et al. 2013; Newschaffer et al. 2007).
Autism is a neurodevelopmental disorder (Myers & Johnson 2007; Geschwind 2008) associ- ated with impaired social skills, lacking communication skills, and repetitive and restrictive behaviour (Haney 2002; The Individuals with Disabilities Education Act [IDEA], 1999).
Symptoms start to develop around 6 moths age steadily without remission (International Statistical Classification of Diseases and Related Health Problems [ICD-10], 2007), and are typically established at the age of 2–3 years (Roger & Sally 2009). Parents usually notice the first signs of autistic behaviour during the first two years of their child’s life (Myers & John- son 2007). The symptoms associated with autism spectrum disorder, such as continuous and repetitive engagement in odd activities, unusual responses to social and physical situations and difficulties dealing with environmental change can impair children’s educational perfor- mance and make it challenging for them to relate to their peers.
Children with autism spectrum disorder have difficulties perceiving bodily boundaries (Shearer, Kohler, Bunchan & McCullough 1996) resulting in motor deficiencies (Berkeley, Zittel, Pitney & Nichols 2001). This results in the inability to participate in sports and other physical exercise thus denying the autistic children the opportunity to develop ordinary mo- tor skills (Berkeley et al. 2001). In their study, Berkeley et al. (2001) confirmed delays in the motor development of autistic children and also concluded that motor skill reinforcement is critical even for the children at the high-functioning end of autism disorder.
Early intervention using physical and occupational therapy has been demonstrated to be ef- fective in improving both gross and fine motor skills (Filipek et al. 2000). A well-designed adapted physical education (APE) program ensures the best possible opportunities to devel- op and practise of these crucial skills (FIlipek et al. 2000).
Improving the availability and quality of APE offered for children with special needs could greatly improve their abilities to interact with their peers and relieve their challenges regard- ing motor skills. Also, the variation within the individual skills and limitations within any given APE group limits the applicability of any one program. This poses a great challenge for APE educators of autistic adolescents, as the individual need for APE vary greatly.
This thesis studies autism spectrum disorder among 12-17-year-old adolescences and devel- ops an adapted physical program for Väinölä School. The purpose of this thesis was to con- struct an adapted physical education program taking into account the individual skills and limitations of autistic adolescents. The aim of this thesis was to develop an APE program suitable for participants with various skill levels and developmental stages. The physical ac- tivity program constructed for Väinölä School which consentrated on providing special edu- cation for children with mental and physical disorders.
Väinölä School provides a variety of different forms of education and other special services, and educates kids with various developmental disorders from different age groups. Teachers instructing the classes are specialized in working with children and adolescents with special needs. Each physical activity class includes children with various motor skills and different disorders, and is thus constructed to be suitable for all participants. This thesis helps the teachers of Väinölä School to provide adapted physical activity classes especially for autistic adolescents, and to assess students’ individual challenges and motor skills that need devel- opment most.
The research data were gathered by the qualitative research method. The physical activity program included various physical activity lessons for adolescents with autism spectrum dis- order for a 6-month period according to their physical activity level. A series of observing sessions were held for the participants to acquire a comprehensive understanding on their individual motor skills. After the observing period, every participant passed a physical activi- ty test. The data from the tests were collected and evaluated, and a physical education pro- gram was made based on the results. This program included adapted exercises to evaluate and develop especially locomotor and stability skills.
Väinölä School commissioned this thesis because of their interest in developing their stu- dents’ physical activity level. This research and final data results provided new information for the staff members of the school. Moreover, they got new knowledge about the devel- opment of the locomotor and stability skills of their autistic students. The author’s personal aims were to better understand the nature of autism spectrum disorder, and especially chil- dren and adolescents affected by it. Special attention was given for difficulties related to lo- comotor and stability skills. The thesis supports the author’s professional development, as the author is planning to work with people affected by autism disorder. This thesis also greatly benefits Väinölä School, as it can apply the results and the developed APE program to its physical education curriculum. Kajaani University of Applied Sciences (KUAS) bene- fited from novel collaboration with Väinölä School provided both KUAS and Väinölä School with excellent competences to utilize each other’s expertise and practical experience regarding physical education. Also, the research data form the collaboration can be used for educational purposes at the KUAS.
2 AUTISM DISORDER
Autism means a whole spectrum of disorders with neurological origins (Myers & Johnson 2007; Geschwind 2008). Autism disorder affect people in multiple ways with symptoms rag- ing from mild to severe (Wolfberg 1999, 22). Most typical symptoms associated with autism disorder include hindered social and communicational skills, as well and repetitive and re- strictive behaviour (Haney 2002; IDEA, 1999). Thus, people with autism disorder have im- paired skills related to reciprocal social interactions, and suffer from inflexible behaviour and limited imagination (Wolfberg 1999, 22).
Autism is considered to be a behavioural syndrome and developmental disability rather than a disease (Gerdtz & Bregman 1990, 14). Autism can be seen as a behavioural syndrome as people with autism often engage in clusters of repetitive behaviour which separates them from non-autistic people (Haney 2002; IDEA, 1999; Gerdtz & Bregman 1990, 14). The be- havioural models associated with autism can be separated into four broad categories (adapted from Cohen, Paul & Volkmar 1987, 30):
1)! Difficulties with social relationships 2)! Severe deficits in language
3)! Severe deficits in communication 4)! Other associated features
The prevalence of autism disorder was 2% among children from 6–17 years old in 2011–
2012, while in 2007 only 1.17% of the children with the same age were affected by the dis- order (Blumberg et al. 2013). The prevalence of autism disorder has increased dramatically from 1980s, partially due to increased diagnostic capabilities, making it difficult to estimate how much the actual prevalence of the disorder has increased (Blumberg et al. 2013;
Newschaffer et al. 2007; Sewell 1998, 6). There are roughly two to four times more males than females suffering from autism disorder (Wolfberg 1999, 16).
Mental retardation is strongly associated with autism disorder as evaluated by standardized intelligence tests (Wolfberg 1999, 16). Autism is frequently accompanied by mental retarda- tion based on standardized intelligence tests, with approximately 60% having scores of be-
low 50, 20% having scores between 50 and 70), and 20% with scores greater than 70 (Aarons & Gittens 1992, 22; Wolfberg 1999, 16). Despite their higher level of intellectual capabilities, the 20% with IQ scores over 70 still almost certainly encounters difficulties and require additional support from parents, teachers and peers when compared with people not affected by autism (Aarons & Gittens 1992, 22).
Although most people with autism disorder suffer from intellectually retardation, small numbers of autistic individuals are not intellectually impaired in the usual sense (Aarons &
Gittens 1992, 22). Thus autism should not be described simply as being mentally handicap, as this is not true for all people with autism disorder (Aarons & Gittens 1992, 22).
There are many similarities between autism and mental retardation; however they are not the same condition (Gerdtz & Bregman 1990, 27). Similar to autism, mental retardation is both a behavioural syndrome and a developmental disability, and over 70% of autistic people are also mentally retarded (Gerdtz & Bregman 1990, 27).
Also, autism may be associated with other conditions, such as obsessive-compulsive disorder or Tourette’s syndrome (Wolfberg 1999, 16). Also seizure-related conditions could be asso- ciated to autism disorder (Wolfberg 1999, 16).
Since children even normally have lower levers of intelligence when compared with adults, a small percentage of autistic children have relatively high, sometimes even normal, intelli- gence for their age group. The most severally autistic children are generally the most several- ly mentally handicapped, whereas autistic children with close to normal intelligence suffer mainly from impaired verbal skills (Aarons & Gittens 1992, 22).
2.1 History of Autism
Kanner described the condition called autism for the first time in 1943 (reviewed by Aarons
& Gittens 1992, 8). The condition was described by enlisting a set of features common in children with the disorder. Kanner did not invent the term “autistic”, but was the first one to use the term in its current meaning; previously the term had been used to describe with- drawal into imaginary world by schizophrenia patients (Aarons & Gittens 1992, 8). Kanner had also concluded the disorder would have affected mostly children from higher socio-
economical classes and children of well-educated parents, which is later shown to be false conclusion, most likely due to observational bias (Aarons & Gittens 1992, 8).
When describing the autism disorder, Kanner highlighted nine key points, which are still rel- evant in diagnosing the disorder (reviewed by Aarons & Gittens T 1992, 9):
1)! An inability to develop relationships 2)! A delayed acquisition of language
3)! Non-communicative use of spoken language
4)! Delayed echolalia (repetition of words and phrases, which is very common for autis- tic children)
5)! Pronominal reversal 6)! Repetitive play
7)! Maintenance of sameness 8)! Good rote memory
9)! Normal physical appearance
Later Kanner suggested that these nine points could be reduced to only two essential ones (reviewed by Aarons & Gittents 1992, 9):
1)! Maintenance of sameness in repetitive routines
2)! Extreme aloneness that onsets within the first two years of life
This was considered confusing, as only the children with the most classic forms of autism fit these two criteria, when in fact there were many more children with different difficulties (re- viewed by Aarons & Gittens 1992, 9).
Already in 1970s, based on thousands of case histories from autistic children, researches were aware that there were two major groups of children with autism (Furneaux & Roberts 1977, 23):
1)! Those who show normal behaviour, except having an unusually good or normal abil- ity in limited area (but not speech)
2)! Those with normal development up to two years, and then development of autistic behaviour
Regarding the second group (group 2) however, there has always been much debate about whether autistic children ever demonstrate normal communication or other abilities even before the age of two, as children’s normal abilities wide that it’s often times difficult to as- sess if any particular behaviour can be considered normal (Furneaux & Roberts 1977, 23).
Thus many autistic traits before the age of two might just be mixed with normal childlike behaviour.
2.2 Types
Currently two different classifications are used to diagnose autism disorder. The Internation- al Classification of Diseases (ICD-10) by World Health Organization (1987) and the Diag- nostic and Statistical Manual of Mental Disorders (DSM-IV) by American Psychiatric Asso- ciation (1994) are both commonly used. The DSM-IV criteria for autism disorder can be found in the Appendices. While both classifications have same essential criteria for autism disorder, they often use different terminology (Wolfberg 1999, 16). The DSM-IV separates autism disorder into many subtypes under pervasive developmental disorders, including au- tistic disorder, Rett’s disorder, childhood disintegrative disorder, Asperger’s Disorder and otherwise not-specified pervasive developmental disorder (Wolfberg 1999, 16).
All of these conditions appear within the first years of life, and are associated with severely impaired development of normal social interactions, limited verbal and nonverbal communi- cation, limited imaginative abilities and restricted and repetitive behaviour (Wolfberg 1999, 16). Also stereotypical behavioural patterns, interests and activities are typically present in different form of autism (Wolfberg 1999, 16). All of the aforementioned traits must be pre- sent for the diagnosis of any autistic disorder (e.g. classic Kanner’s autism) (Wolfberg 1999, 16).
As the brain abnormalities underlying autism cause first symptoms early in life, autism can be distinguished from other psychiatric disorders that might induce similar symptoms, such as schizophrenia, where the symptoms typically emerge later in life (Wolfberg 1999, 16).
However, distinguishing autism from other pervasive developmental disorders can be more difficult, but can be done in numerous ways (Wolfberg 1999, 17). Rett’s disorder has only been diagnosed in females, and it’s characterized by diminished head growth, as well as loss of purposeful hand skills and poor coordination (Wolfberg 1999, 17). Children with child- hood disintegrative disorder develop first normal communication skills and social relation- ships as opposed to autistic children, but regress afterwards (Wolfberg 1999, 17). Individuals with Asperger’s syndrome have fairly normal language development and intelligence, how- ever they suffer from problems with social interaction and stereotypical behaviour (Wolf- berg 1999, 17).
A psychiatrist or specialized and licensed psychologist formally diagnoses autism disorder.
The diagnosis is based on both direct observations of the patient and interviews with the parents and other family members (Gerdtz & Bregman 1990, 19). Given the nature of the autism disorder, a detailed life and family histories ought to be an important part of the di- agnosing process (Gerdtz & Bregman 1990, 19). DSM provides a systematic method for di- agnosis of autism disorder, and most professionals rely on this while diagnosing autism dis- orders (Gerdtz & Bregman 1990, 19).
National Society for Autistic Children (NSAC) has provided a nine-point list to help diag- nosticians with the diagnosis of autism disorder (Furneaux & Roberts 1977, 24). The NSAC list contains more detailed information when compared with the original list revised by Kanner in 1943, making the diagnosis a more streamlined process (Furneaux & Roberts 1977, 23). The list provided the NSAC is as follows (Furneaux & Roberts 1977, 23):
1)! Gross and sustained impairment of emotional relationships with people 2)! Self-examination
3)! Pre-occupation with particular objects, or certain characteristics of them, without re- gard to their accepted functions, persisting long after the baby stage
4)! Behaviour leading to suspicious of abnormalities of the special senses in the absence of any obvious physical cause
5)! Sustained resistance to change in the environment, and a striving to maintain order or sameness
6)! Abnormalities of moods 7)! Speech disturbances
8)! Disturbances of movements and general activity
9)! A background of serious retardation in which islets of normal, near normal, or ex- ceptional intellectual function or skill may appear
There are however many confounding factors with the NSACs list, such as the fact that they do not specify how many criteria need to be covered for the diagnosis (Furneaux & Roberts 1977, 23). The list also does not consider the age at which the features become prominent, even thought this has been proposed to be a major diagnostic factor (Furneaux & Roberts 1977, 23). Also one important limitation within the list is the fact, that it only contains posi- tive abnormalities, whereas also the negative symptoms (what the autistic children no not do) are important for accurate diagnosis (Furneaux & Roberts 1977, 25).
There are many more standardized scales and instruments in addition to the aforementioned ones. Most notably, these include Childhood Autism Rating Scale (CARS) and Autism Screening Instrument for Educational Planning (ASIEP). Both CARS and ASIEP are used when differentiating autism from other handicapping conditions and while setting goals and objectives for autistic people (Teal & Wiebe 1986).
Referring to the aforementioned lists by NSAC and Kanner, to be diagnosed with autism a child must have difficulties interacting with others, impaired communication skills and they must demonstrate restricted interests. In principle the diagnosis is easy, but since no biologi- cal or chromosomal test for autism exists, even though most agree that the disease has a neurological origins (Myers & Johnson 2007; Geschwind 2008), there is always a bias in the diagnosis based on the individual diagnostician (Koegel & LaZebnik 2004, 2). Practically the diagnosis based on the observation of the three symptoms, and the expression of them can vary based on the individual (Koegel & LaZebnik 2004, 2). Hence, the diagnosis of the au- tism disorder is far from a simple process, and sometimes even skilled and experienced pro- fessionals do not agree on the definite diagnosis (Sugiyama & Abe 1989). Often times there
is a larger team of professionals is consulted before a conclusive diagnosis can be achieved (Gerdtz & Bregman 1990, 20).
The prevalence of autism has increased considerably during the recent years, at least partially due to the increased diagnostic capabilities (Blumberg et al. 2013; Newschaffer et al. 2007;
Sewell 1998, 6). Recent advancements in knowledge base regarding the autism have made psychiatrists, neurologists, medical doctors and other professionals much more aware of the diagnostic process, and the incidence of incorrect diagnoses has notably decreased (Sewell 1998, 6). The increased diagnostic accuracy has also led earlier onset on the treatment, as well as helped the people formerly diagnosed just as mentally retarded or handicapped to receive proper diagnoses (Sewell 1998, 6).
2.3 Reasons for Autism
The exact ethology of autism is unknown, but already since Kanner’s time, many different theories have been suggested (Aarons & Gittens 1992, 17). For example, it has been sug- gested by Tinbergen & Tinbergen in 1972 that autism is caused by somehow inadequate bonding between the mother and the child (reviewed by Aarons & Gittens 1992, 17). This theory placed the blame for the autism partially on parents, and it was suggested that with intensive psychotherapy the child could “break through the autistic barrier” and that this way autism could be cured (reviewed by Aarons & Gittens 1992, 26). However, no data exist supporting the theory that parents would cause autism, and since the prevalence of autism is similar across all cultures, geographical areas and socio-economical groups, links to social or environmental factors are unlikely (Aarons & Gittens 1992, 17).
Autism is more common in boys than in girls; there are roughly 2–4 times more autistic boys than girls (Wolfberg 1999, 16; Aarons & Gittens 1992, 19). The higher prevalence of autism in males, taken together with the association to severe mental retardation suggests that the causes of autism are not psychogenic (Aarons & Gittens 1992, 19). It has been shown, that relatives of autistic people not only stand a higher change of being autistic themselves, but also have a higher probability minor cognitive disabilities, such as speech disorders and learning difficulties (Aarons & Gittens 1992, 19). This would seem to suggest at that there is at least some genetic component to the condition.
The current consensus among researchers is that autism is the result of an injury or dysfunc- tion of the central nervous system (Gerdtz & Bregman 1990, 27; Myers & Johnson 2007;
Geschwind, 2008). This injury could result from a wide variety of different factors including the following (Gerdtz & Bregman 1990, 27):
-! Prenatal events (e.g. toxaemia)
-! Perinatal events (e.g. trauma, anorexia) -! Congenital factors (e.g. microcephaly) -! Chromosomal factors (e.g. XYY syndrome) -! Metabolic factors (e.g. Addison’s disease) -! Other factors (e.g. meningitis, encephalitis)
Despite there being vast body of evidence for autism being caused by central nervous sys- tem injury, the exact mechanisms on how to injury leads to autistic behaviour are still un- known (Gerdtz & Bregman 1990, 27).
Autism is also associated with epilepsy, although sometimes the onset of epilepsy takes place at adolescence whereas autism is diagnosed at an early age (Aarons & Gittens 1992, 20). Al- so, the severity of the autism seems to correlate with epilepsy, as more severely handicapped autistic children suffer on average more often from epilepsy (Aarons & Gittens 1992, 20).
This association between autism and epilepsy further supports the theory of the organic ba- sis for autism (Aarons & Gittens 1992, 20).
The specific areas of the brain affected by autism have been studied extensively, but no con- clusive evidence for any single damaged area as the cause of autism has been found (Aarons
& Gittens 1992, 20). Thus, it is much more likely that autism is caused by multiple coexisting neurological deficits (Aarons & Gittens 1992, 20).
Also endocrine reasons for autism have been studied, and around one third of autistic chil- dren show high levels of serotonin in their bloodstream (Aarons & Gittens 1992, 20). How- ever, pharmacological reduction of serum serotonin levels by the use of fenfluramine has not proven to be effective in treatment of autism (Aarons & Gittens 1992, 20).
Taking all the evidence for different possible aetiologies of autism into account, the current consensus is that for autism to develop, there needs to be genetic predisposition to the brain damage, with many other heterogeneous factors coexisting within every autistic patient (Aarons & Gittens 1992, 20).
2.4 Treatment
No curative treatment for autism exists, however almost all children with autism disorder improve considerably with appropriate interventions (Koegel & LaZebnik 2004, 11). There has been, and there still is, continuous progress made in the treatment of autism (Koegel &
LaZebnik 2004, 11). Even though no “cure” for autism exists, it has been shown that with adequate education for their need, some autistic individuals are able to life relatively inde- pendent lives (Furneaux & Roberts 1977, 192).
The early diagnosis is the cornerstone of a successful treatment. In general, the treatment does not aim to cure autism itself, but rather help the autistic children to function better Myers & Johnson 2007). There is vast variety within the symptoms between different autistic children, and thus treatment needs to be tailored to everyone’s individual needs (Myers &
Johnson 2007). In general, the best results are achieved by using a highly structured and spe- cialized treatment programs, which aim to improve communicational, social and behavioural skills (Myers & Johnson 2007). Also, in most cases, a combination of multiple treatment modalities is beneficial (Myers & Johnson 2007). Also, it is not realistic to expect that com- plex condition such as autism could be cures or treated using a single method (Aarons &
Gittens 1992, 85).
Following treatments for autism are recommended by U.S.A National Institutes of Health (NIH) (National Institute of Mental Health [NIMH] 2011):
1)! Behavioural Management therapy 2)! Cognitive behaviour therapy 3)! Early intervention
4)! Educational and school-based therapies 5)! Joint attention therapy
6)! Medication treatment 7)! Nutritional therapy 8)! Occupational therapy 9)! Parent-medicated therapy 10)!Physical therapy
11)!Social skills training 12)!Speech-language therapy
Behavioural Management therapy
Several different methods for modifying the autistic behaviour have been used. Most meth- ods are based on rewarding the desired behaviour, leading into this behaviour being more likely repeated than ignored behaviour. This method is in general called applied behaviour analysis (ABA). Behaviour modification focuses on skills where the individual needs most development. Skill-oriented and structured activities are oftentimes included. ABA requires intense training and requires extensive therapist and parent involvement.
Sensory integration therapy is a specific form of behaviour management therapy that aims to help autistic people to respond normally to sensory stimulation. Treatment includes expos- ing the autistic children to different forms of sensory stimulation by giving them objects dif- ferent textures or making them listen to different sounds.
Play therapy is used to improve emotional development of autistic children, as social interac- tions of autistic people are often times limited by their impaired emotional development. In play therapy, the child controls an adult-child interaction.
In addition to play therapy, social stories are often used to improve social skills. The purpose of the stories is to help autistic children to understand the viewpoints and feelings of other people, and to make them alternate responses in different situations. They also help autistic children to understand their own feelings in different scenarios.
Communication Therapy
Autistic children who are having problems with either verbal or non-verbal communication are often times treated using so called communication therapy, whereas speech therapy is used to help autistic children to gain the ability to speak. For these purposes, picture ex- change communication systems are used. In this form of therapy the individuals are able to communicate simply using only pictures, which can represent activities, items, ideas, re- quests, need, etc.
Dietary Modifications
There is no proof of autism being caused by the diet, and the use of dietary modification as a therapy is controversial. Food intolerances or allergies might contribute to some behav- ioural problems with certain autistic individuals, in which case changes in diet could help individuals with digestion and eliminate food intolerances.
Elevated levels of gluten and casein have been reported in autistic individuals, suggesting that incomplete digestion or excessive absorptions of these substances might be associated with autism disorder. It has also been reported that vitamin supplements (A, B, C and D) might improve behaviour and reduce depression in autistic people.
Autism Prognosis
The prognosis varies between different autistic people. Autistic people have normal life ex- pectancies, and with good treatment autistic individuals are able to function productively and have decent level of independence. However, some autistic people require lifelong assis- tance (Stanley & Swierzewskii 2000).
Occupational therapy
In occupational therapy, basic skills (such as buttoning a shirt) are taught for the autistic children (Stanley & Swierzewskii 2000).
Physical therapy
In physical therapy exercise and other physical activities are used to help autistic individuals to attain better level of control over their own bodies (Stanley & Swierzewskii 2000).
Medication
No specific medication for autism disorder exists, but a many psychotropic drugs have been demonstrated to have clinical benefits. However, the research is relatively limited, and only few carefully conducted trials demonstrating the efficacy and potential side effects have been conducted. Thus, it is difficult to predict the subgroups of patients that would benefit from medical therapy (Gerdtz & Bregman 1990, 123).
Autistic individual experience many forms of behavioural and emotional disturbances. This might predispose them for other psychiatric disorders, which might in turn require medical therapy. In treatment of these individual, medical therapy is an integral part of the overall treatment (Gerdtz & Bregman 1990, 123). Neuroleptics, lithium, opioid antagonists, beta- blockers and stimulants are often used based on the symptoms (Gerdtz & Bregman 1990, 117).
In addition to psychotropic drug, also psychotherapy has been tested in treatment of autism (Aarons & Gittens 1992, 88). This has resulted in some cases from not acknowledging au- tism, but assuming that children’s’ problems were of emotional origins (Aarons & Gittens 1992, 88).
3 ADOLESCENTS WITH AUTISM DISORDER
Adolescence is the most difficult, complicated and stressful period of physical and psycho- logical growth and development for both teenagers and families (Gerdtz & Bregman 1990, 88; Furneaux & Roberts 1977, 121). Autistic adolescents are dubious, frustrated and facing difficulties based on their educational and communal development, which is making the in- fluence for their future adult life and social development (Furneaux & Roberts 1977, 121;
Gerdtz & Bregman 1990, 88).
Based on the physical and psychological development, challenges can be categorized into 3 separate sections (Gerdtz & Bregman 1990, 89):
1)! Physical growth and development 2)! Need for independence
3)! Being part of the group
Issues faced by the autistic adolescents in physical growth and development cannot be sepa- rated to medical problems and communal complications (Gerdtz & Bregman 1990, 95). As J.Gerdtz and J. Bregman stated in their book “Autism: a practical guide for those who help others”: “If the teenager with autism is severely disabled, his or her physical development will soon outpace cognitive and emotional development” (1990, 95). The medical problems and social challenges of the autistic adolescents are deeply intertwined.
Autistic adolescents mostly ignore the use of speech for communicating with people and it is rare that they commonly use reciprocal interactions, gestures or body movements (Rosen- berg, Wilson, Maheady & Sindelar 1997, 86).
3.1 Emotional and Psychological Development of Autistic Adolescents
Complicated behaviour can cause difficulties in eating and sleeping during the childhood period, and as autistic kids are growing old they get accustomed to those habits, but many other difficulties tend to continue (Furneaux & Roberts 1977, 132). For instance hyper-
activity, aggression, destructiveness, temper tantrums, negativism, ritualistic and obsessional behaviour characterize autistic behaviour even at older age (Furneaux & Roberts 1977, 132).
When autistic children grow older, difficulties in upbringing can appear as hyper-activity, explosive outburst and erratic behaviour, thus the need of containment of special teaching and social programs is increasing (Furneaux & Roberts 1977, 132-133).
However, some of the behavioural abnormalities which are inherent in autism disorder, such as obsessional and ritualistic behaviour, or self-mutilation (e.g. head banging, biting hands and arms, throwing themselves on the floor) can be transferred into positive flow with addi- tional control and elimination of other behavioural distortions (Furneaux & Roberts 1977, 133). Under those circumstances, if the additional and constant strict control will be provid- ed, adolescents with autism disorder can develop their own sense of individuality and self- responsibility, as well as become more emotionally stable and mature (Furneaux & Roberts 1977, 133).
As previously stated, the adolescents with autism disorder can improve their outburst and impermanent behaviour by having the additional control from the community over a long period of time (Furneaux & Roberts 1977, 134). Nonetheless, supplementary training is needed in order to develop proper responses in social situations (e.g. proper behaviour at public places, in transport, other people’s homes, the proper selection of clothing to wear according to the weather and occasion) and to organise own leisure time activities (Furneaux
& Roberts 1977, 134).
In addition, at least 50% of adolescents with autism disorder have impaired capabilities for emphatic speech, and impairments of more sever in girls than in boys (reviewed by Rosen- berg et al. 1997, 85). By the same token, autistic children can show peculiar features if they are establishing good speaking abilities, with echolalia being the most frequently observed abnormality (Rosenberg et al. 1997, 86). Teenagers with autism are rarely using the speech as their main communicational tool, and some of the normal retaliatory connections working as they are supposed to, but issues with understanding the spoken language can appear (Rosenberg et al. 1997, 86).
3.2 Physical Growth and Motor Development in Adolescence
Nowadays, the period of adolescence is starting at the age of 10 and lasting as far as the per- son reaches the age of 20 or above, the prolongation of which was caused by biological and cultural effects (Gallahue & Ozmun 1995, 367). Change from childhood to adolescence is characterized by meaningful physical and cultural events, which causes the progress of mo- tor development, especially to males in various motor skills (Gallahue & Ozmun 1995, 367;
Gabbard 2012, 330). By way of example, the period of adolescence can occur some biologi- cal changes, which can be recognised by the appearance of the growth spurt, the onset of puberty, and sexual maturation (Gallahue & Ozmun 1995, 367).
The increases in person’s height and weight, its’ starting age, duration and intensity of the growth development are individual features of the adolescents, with vast case-by-base varia- tion (Gallahue & Ozmun 1995, 367). Moreover, the gender difference is also playing a very important role in physical development. Gallahue and Ozmun made in their book the fol- lowing statement: “The adolescent growth spurt lasts four years, beginning in females about two years earlier than in males” (1995, 369). For instance, for boys the average age of the beginning of the growth burst is 11 years and it lasts up to the age of 13, and uniformly de- creasing by reaching the 15 years old period (reviewed by Gallahue & Ozmun 1995, 368;
Gabbard 2012, 93). For girls, the average age of the burst of height growth is from 9 to 13 (reviewed by Gallahue & Ozmun 1995, 368).
Regarding the growth development, males are growing at least for 2 years longer than fe- males. For instance, males are reaching their mature adult heights when they are at the age of 18, and females are noted to achieve their maximum heights at the age of 16 (reviewed by Gallahue & Ozmun 1995, 369). As a consequence of the varying growth development in adolescence, the development of fundamental movement skills also varies, which is com- mon for the general motor development of children (Gallahue & Ozmun 1995, 225). Fun- damental movement skills involve 4 patterns such as body management, locomotor and ob- ject control skills and form the basis for more advanced and specific movement activities (Education Department of Western Australia [EDWA], 2013, 15; Gabbard 2012, 283). In order to control the appropriate development of the fundamental movement skills, the envi- ronment and factors such as circumstances within the environment, enthusiasm and objec- tives of the tasks must be taken into account (Gallahue & Ozmun 1995, 280). To summarize
the preceding information, Gallahue and Ozmun stated in their book: “Motor development is progressive change in motor behaviour throughout the life cycle, brought about by inter- action among the requirements of the task, the biology of the individual, and the conditions of the environment” (1989, 3).
Subsequently, the effect of opportunities for practicing, qualified instructions and communi- ty encouragement provided for teenagers, can play a very important and significant role in the development of the specialized movement skills (Gallahue & Ozmun 1995, 386). Ado- lescents are making an effort towards improving and matching personal mature movement patterns during the transition phase (Gallahue & Ozmun 1995, 389). Therefore the aware- ness of the physical abilities and limitations, which is eventually supporting the interest only in limited sport activities, is appearing during the application stage of adolescence (Gallahue
& Ozmun 1995, 389). As a result, the final stage in supporting autistic adolescents in sports is to decrease the amount of overall sport activities, and focusing on the specialized activities proper for them (Gallahue & Ozmun 1995, 390). As a final point, physical education and sports are the factors, which have enormous impact on motor skill development and modi- fication throughout the childhood and adolescence periods (Gabbard 2012, 341).
3.3 Physical Growth and Motor Development of Adolescents with Autism
Nowadays, it is known that people with Rett’s disorder and Childhood Disintegrative (CDD) disorder are suffering from a shortage of physical and motor abilities, and also that people with Asperger syndrome are facing difficulties by being clumsy (reviewed by Winnick 2011, 201). However the research on autistic people and their physical and motor skills re- mains unconvincing (reviewed by Winnick 2011, 201). In contrast, the early research made by Rimbland in 1964 concluded that children with autism disorder are having the motor de- velopment and movement skill patterns developing in a similar way to normal children (re- viewed by Winnick 2011, 201). Lately, Sigman and Capps in 1997 specified the fact that au- tistic kids differ in the physical characteristics from kids with Asperger Syndrome by the fact that their physical development and motor coordination are greatly developed, moreover the maintenance of advanced physical skills can be reached and evaluated in adolescence (re- viewed by Winnick 2011, 201).
To understand motor development of autistic individuals, in 2002 Reid and Collier summa- rized their findings by stating that autism disorder is mostly associated with delay of the movement skills and clumsiness (reviewed by Winnick 2011, 201). Based on the controver- sial examples provided by Reid and Collier in their study, autistic people can be in decent physical condition and agile, but the research should be continued in order to get conclusive results (reviewed by Winnick 2011, 201). Moreover, it was also shown in the results of the study that autistic people are having a lack of motivation and intelligence to complete several motor tests to evaluate their physical activity level (reviewed by Winnick 2011, 201). Also, Levinson and Reid in 1993 suggested that by reducing stress, self-stimulatory and destructive behaviour, people with autism disorder could improve their physical activity (reviewed by Winnick 2011, 201).
All gross motor skills are developing opportunistically, for instance systematic development of locomotor skills can be divided at least into 13 milestones such as rolling, crawling (e.g.
stomach touches ground), creeping (e.g. one hand on object), cruising (e.g. one hand on ob- ject), walking, jumping, running, hopping, climbing, sliding, galloping, dodging, and skipping (Jansma & French 1994, 55). The statement by Jansma and French highlights important key points in development of motor milestones: “For a stage of development to be fully set for the emergence of developmental voluntary motor milestones, a youngster needs to inhibit all primitive reflexes, differentiate mass random bodily movements, process incoming stimuli, and possess at least minimum fitness (strength, heart-lung endurance and flexibility) to re- spond motorically to environmental demands voluntarily” (1994, 56).
Specific motor skills, such as manual control (i.e. writing), manual dexterity (i.e. coordina- tion), ball skill, walk, balance, body coordination, strength and agility, paxis, imitation, pos- tural stability and speed are commonly impaired in adolescents with autism disorder (Song 2013).
Autistic adolescents, who are limited in their gross motor activities on the regular basis are more unsocial with peers, and face problems with interacting and taking part in socially age- appropriate activities (Stanley Jones & Associates [SJA] 2012). Moreover, those skills should not be limited in order to avoid additional difficulties with gross motor skills development (SJA 2012). Adolescents with autism are having a lack of self-understanding and their rela- tion to the environment (Reynolds & Dombeck 2006). For instance, they cannot understand
the definite placement of their bodies and its’ location in relation to their actual surround- ings (Reynolds & Dombeck 2006).
Coordination and motor skills are also affected because of abnormal or late vestibular re- sponses, which causes issues with ability of body to coordinate (Song 2013). This is because subjective awareness of the body position and movement in space are allowed by the vestib- ular system, which plays an important role in the combination of the sensory processes (Song 2013).
Adolescents with autism disorder are stated to have poor upper-limb coordination while completing visuomotor or manual dexterity tasks, as well as poor lower-limb coordination (Song 2013). As Sewell established in her book “Breakthroughs: how to reach students with autism”, “Many have good-to-superior fine and gross motor skills, but some walk with a pe- culiar gait, or ‘toe-walk’. Some walk with arms hanging down by their side instead of recip- rocal swinging when the opposite foot is put forward. Some have what seems to be a
“willed” limpness in their fingers and hands” (1998, 241).
4 ADAPTED PHYSICAL EDUCATION
Adapted physical education (APE) is a special educational method for developing, imple- menting and observing already existing physical education programs, which are modified to learners with disabilities. The purpose of the APE is to provide these individuals with need- ed skills to experience and enjoy physical activities and sports safely (Jansma & French 1994, 4). The main focus of the APE is the development of knowledge and skills in psychomotor areas such as physical, motor, fitness and play elements, which can be applied into supple- mentary activities at school or in some post school psychomotor practices (Jansma &
French 1994, 2).
Adapted physical education and related sports programs which are modified for the individ- uals with disabilities have been proven to help individuals who involved to accomplish cer- tain goals and make improvement, which would have been otherwise thought to be impos- sible (Winnick 2011, 3).
4.1 Definition and Nature of APE
The term APE was introduced in 1952 by the American Association for Health, Physical Education, and Recreation (AAHPERD), while being published with the guidelines as a rec- ommended subject at schools for students with disabilities in order to safely and effectively participate in vigorous and standard physical education programs (Sherrill 2004). Based on the AAHPERD, APE is customized and multilateral program of physical activities, games, sports, and rhythms, based on the interests, abilities, and limitations of participants with dis- abilities who may not safely and effectively be interested and involved into vigorous activi- ties of the standard physical education program (West Chester University Of Pennsylvania [WCUP] 2011).
Justified practice of APE is based on the fact that each student has the ability and motiva- tion to move, to be active, and be involved into physical activities with the peers (Connecti- cut State Department of Education [CSDE] n.d.). Moreover, all students with disabilities should be involved into qualified physical education program with modified lessons and the equipment, that supervise their individual needs and offers them the opportunity to benefit
and access their potential physical activity level (CSDE n.d.; WCUP 2011). Thus, well- educated and qualified specialists provide APE to the participants who have necessity for it and cannot participate in standard physical education program (CSDE n.d.).
Under those circumstances, adapted physical activity can be described by the delivering the services such as pedagogy, instructing, rehabilitation or therapy conducted by professionals in order to evaluate and develop physical activity level of individuals of all age groups with limitations (Sherrill 2004, 3).
4.2 APE for Autistic Adolescents: Ethics and Reliability
Based on the Education Act implemented in 1981 with the emphasis on providing for indi- viduals with disabilities special assistance by educating autistic children based on their level of functioning, not based on the diagnosis (Aarons & Gittens 1992, 72). The term “autistic”
includes a broad range of disabilities and behaviour, involving many or few features of au- tism, and the specific diagnosis does not necessarily reflect the individual’s level of physical capabilities (Aarons & Gittens 1992, 72).
Notably, autistic individuals who are less affected and not demonstrating behaviour abnor- malities are able to participate in mainstream education (Aarons & Gittens 1992, 74). How- ever, the overall number of autistic individuals who are able to access mainstream education is very limited, because the majority of individuals suffer from mental retardation (Aarons &
Gittens 1992, 75).
Regardless of the fact that the special education raises ethical issues, the ethics of special ed- ucation is not receiving close enough attention (Howe & Miramontes 1992, 1). Moreover, the field of ethical assessment is not adequately addressed during teacher education (Howe
& Miramontes 1992, 1).
Based on the Council for Exceptional Children (CEC) Code of Ethics, Howe and Miramontes declared the following principles in their book “The Ethics of Special Educa- tion” (1992, 119):
1)! Special education professionals are committed to developing the highest educational and quality of life potential of exceptional individuals
2)! Special education professionals promote and maintain a high level of competence and integrity in practicing their profession
3)! Special education professionals engage in professional activities, which benefit ex- ceptional individuals, their families, other colleagues, students, or research subjects 4)! Special education professionals exercise objective professional judgment in the prac-
tice of their profession
5)! Special education professionals strive to advance their knowledge and skills regard- ing the education of exceptional individuals
6)! Special education professionals work within the standards and policies of their pro- fession
7)! Special education professionals seek to uphold and improve where necessary the laws, regulations, and policies governing the delivery of special education and related services and the practice of their profession
8)! Special education professionals do not condone or participate in unethical or illegal acts, nor violate professional standards adopted by the Delegate Assembly of CEC
4.3 Teaching APE for Autistic Adolescents
Individuals with emotional disorders require physical education programs, which focusing on development of physical and motor fitness, and offered in directed, structured and safe environment (Jansma & French 1994, 177). Moreover, students who are emotionally disor- dered are having the deficits in fundamental motor skills (Jansma & French 1994, 179). Thus the activities, which are enhancing spatial orientation, body image, locomotion, coordina- tion, balance and rhythm must be provided constantly (Jansma & French 1994, 179).
Adolescents should regularly do the exercises for improving the coordination, balance and motor skills with use of the safe equipment and objects, in order to develop the confidence in individual work and improve their essential movement patterns (Jansma & French 1994, 179). For the effectiveness of physical education, it must be planned in advance in organized and controlled environment (Jansma & French 1994, 179). Since it was proven that students
with ASD could demonstrate abnormal behavioural responses when new tasks are presented in a random or unpredictable manner (Winnick 2011, 206).
During the participation in the individual, dual or group activities can provide benefits in psychomotor development as well as modifications in unadapted behaviour (Jansma &
French 1994, 179). Especially the progressive and consistent introduction of the new activi- ties is necessary in working with students who are emotionally disordered (Jansma & French 1994, 184).
As Jansma and French stated in their book called “Special Physical Education. Physical ac- tivity, Sports, and Recreation” the following considerations must be taken into account to provide the essential physical education (1994, 185-186):
•! Play therapy
•! Movement education
•! Coping with fear
•! Grouping pupils
•! Choosing teams
•! Modifying rules
•! Precise signals
•! Controlled aggression
•! Individualizing instruction
While providing APE for autistic adolescent, the difficulty of tasks can be selected based on the individual gross motor skills of the participants, thus enabling both skilled and unskilled participants to benefit from the education (Jansma & French 1994, 184). Also, as the skill level of the participants develops as a result from proper APE, the education remains chal- lenging as the difficulty level can be increased (Jansma & French 1994, 184). Taking the par- ticipants age, needs and interests into account can positively affect the outcome of APE (Winnick 2011, 205).
4.4 Different Approaches to Providing APE for Autistic Adolescents
Nowadays exist a wide range of different approaches for conducting physical education for adolescents with ASD (Winnick 2011, 201). The continuation and extension of the research- es in this field is relevant in order to provide the most relevant approaches to help autistic individuals (Winnick 2011, 201). Based on the research made by Furneaux and Roberts in 1977, the following list of different approaches can be used in teaching individuals with ASD (1997, 144 -151):
•! The psychodynamic approach, which views autism as a condition with emotional origin
•! Behaviour modification, which is based on rewarding or punishment wanted and unwanted behaviour
•! Environmental approaches, which used structured environments to provide autistic individuals with a stable learning environment
5 RESEARCH TASKS
This thesis addresses the topic of physical activity development among adolescents with au- tism spectrum disorder and adapted physical education provided for them. Also, this thesis studies and describes the most common problems in physical development among 12-17- year-old participants at Väinölä School. The aims of the study were to evaluate the physical activity level of the autistic adolescents who took part in gym classes at Väinölä School, and to determine their most severe deficiencies in their motor skills. In addition, the study aimed to determine if the gross motor skills of the autistic adolescents could be improved by using adapted physical education, and to develop an adapted physical program for the autistic ado- lescents.
The research tasks were:
1)! What are the physical capabilities and limitations of autistic adolescents at Väinölä School, and which tests could be used as relevant measures of their physical pro- gress?
2)! How to choose proper physical activity tasks suitable for the students with different activity levels?
3)! Can adapted physical education be used to improve the gross motor skills of the au- tistic adolescents?
6 RESEARCH METHOD
This chapter provides an overview of the research process and methods used. Moreover it describes the commissioner of the study and demonstrating the information on the partici- pants and instruments of the study.
6.1 Commissioner of the Thesis
The commission organization for the thesis is Väinölä School, which is located in Kajaani, Finland. The school is focused on providing special education for children and adolescents with different mental and physical disorders, for whom they provide different education and other services. The school enrols students with different disorders and ages. Teachers in- structing the classes at Väinölä School are educated professionals in the field of providing special education. During physical activity classes close attention is paid to planning the in- structions before classes, since all the physical exercises must be suitable for all participants with different physical activity levels and disorders. Väinölä School has commissioned this thesis because they are interested in developing their students’ physical activity level, and acquiring new adapted physical education program.
6.2 Qualitative Research Method
Qualitative research is done by participant observation or case studies, from which a narra- tive and descriptive account of the studied subject is acquired (reviewed by Guest, Namey &
Mitchell 2013, 2). The typical approach for qualitative research is first to collect comprehen- sive amounts of information by analysing and observing the studied social circumstances and people involved in these circumstances (Gribich 1999, 80; Berg 2001, 6).
As qualitative research involves gathering large amounts of information from different indi- viduals, specific ethical issues arise. Decisions such as, how much any given phenomena will be investigated are integral for qualitative research process, especially when research subjects are notably susceptible, e.g. children (Gribich 1999, 80). Because if this, a critical literature
review and theoretical standpoints are required before choosing the methods for data collec- tion and analysis (Gribich 1999, 80).
Qualitative research is defined by open-ended and inductive questioning, as well as by open- ended observation (Guest et al. 2013, 6). Participant observation is a commonly used tech- nique in qualitative research. It involves researcher to observe subjects’ behaviour, actions and interactions in a proper environment, and leads into collection of very individual data (Guest et al. 2013, 6).
Participant observation method can be used to study many kinds of groups – complete insti- tutions (e.g., hospitals, schools), partial institutions (e.g., a classroom or a department), or single individuals (Gribich 1999, 124). One advantage of participant observation technique is that it grants the researcher with access to the actual environment where the studied pro- cesses are taking place (Gribich 1999, 124).
In addition to the participant observation technique, phenomenology approach to the quali- tative research can also be applied. It is more focused on human experiences, understanding, and opinions, rather than just plain observation of subjects’ actions (Guest et al. 2013, 8).
Participant observation technique and phenomenology approach are by no mean mutually exclusive, but instead support one another, and can often times be used to give the research- er better understanding of the studied subject (Gribich 1999, 122-123).
6.3 Choosing the Proper Research Methods
The first aim of the thesis was to evaluate the gross-motor skills of the autistic adolescents.
For this purpose, the observation method was chosen, as thorough observation of the par- ticipants over a long period of time seemed like the most reliable way to acquire detailed and yet comprehensive understanding of the participants’ motor skills. Simple motor skill testing and numerical analysis of the results to determine their gross-motor development would not have been applicable, since there were only 3 participants. Thus, in this instance, the qualita- tive observation approach was the most proper one. In addition, the data from the observa- tion sessions was not only used to analyse participants’ motor skill level, but also to choose the proper exercises for the APE program and for the testing of the participants’ motor skill
level. The data from the pre- and post-testings’ were analysed by simply comparing the re- sults to determine, if the APE had potentially affected the participants’ gross-motor skills.
6.4 Participants
The main foci of the thesis were to identify the most severe deficits in the motor skills of the autistic adolescents and to determine wheatear they could be improved by using APE. Three male participants from Väinölä School were been observed, evaluated and tested. The age of the participants varies from 12 years old to 17 years old (12, 16 and 17).
The criteria for the selection of the participants were based on the diagnosis (DSM-IV) and amount of the participants in Väinölä School, who were taking part in the physical activity classes.
6.5 Instruments
Special measuring scale was used to evaluate participants’ skills and physical activity level during physical activity testing. All participants were first observed, after which their physical activity level was tested before and after one-month training period. Before the pre and post-testing, all participants were been observed on a weekly basis for 5 months. After the 5- month observation period, the most difficult and weak points regarding the participants’
gross-motor skills were identified. The testing protocol and exercises were designed to spe- cifically measure the gross motor skills where participants showed the weakest points during the observation period.
6.5.1 The Testing Protocol
The testing form with tasks and instructions included 5 different gross motor skills: walking, backward walking, balance, coordination, and crawling. The challenge level of the tasks was increased during the whole process. The testing protocol remained the same during both testing’s.
The testing tasks were chosen based on the results from the observation sessions. Only tasks related to skills with which the participants had demonstrated to have problems with were chosen. Traditional tests of motor skills are difficult to execute while assessing autistic indi- viduals, since some of the tasks might be too challenging or complicated for them to per- form or understand. Thus, the testing tasks for the program were chosen by the author based on the observation sessions in a way, that the tasks would pose enough challenge for the participants, but would not bee overly complex.
In the first task of the testing session, participants were asked to complete the walking for- ward task. The trial included forward walking at the own self-determined pace by the partic- ipants, followed by same exercise while simultaneously performing a cognitive task of nam- ing objects, which were shown with pictures. The distance required to walk was 10 meters.
The second task was otherwise identical to the first, but with the participants walking back- wards while performing a cognitive task.
The third task included a balance exercise, where the participants were asked to stand mo- tionless with one leg with their eyes closed while maintaining balance (participants were al- lowed to choose the leading leg) for 10 seconds. The fourth task included both balance and coordination components. Participants were asked to step in and out of box placed in the ground. A time limit of 30 seconds was applied. A successful completion of the task was measured by the amount of repetitions as well as by overall performance, evaluated e.g. by rhythm and proper technique. Participants could try twice to complete the task; first they would do a warming up where they were allowed to practice the movement and after that, the actual testing.
During the final exercise crawling skills were tested. Participants were asked to complete two crawling trials through the five meters long tunnel. The first trial was completed at partici- pants’ own self-selected pace as a warming-up, after which it was measured, how many times the participants could crawl through the tunnel in 30 seconds.
During the whole testing period, assistance was allowed if the participants were not capable to complete or understand the tasks without additional help.
6.5.2 The Testing Scale
The special measuring scale included four different options to choose from, in order to non- judgmentally evaluate each task performed by the participant. The answer possibilities were the following: 0-unable; 1-needs major help; 2-needs minor help; 3-independent. At the end of the pre and post-testing testing each participant had his own amount of points and feed- back comments as well.
Table 1. Grading criteria
Autistic adolescents have various challenges regarding their motor skills, making the exact numerical evaluation of their skills difficult. Merely recording the number of repetitions, or other relevant measures, would not give representative and realistic image of participants’
actual capabilities. The used scale form 0 to 3 gives a much more relevant understanding of the participants’ actual capability to function when it comes to tasks involving gross-motor skills.
Also, the feedback from the staff members, regarding the overall performance was recorded.
The maximum number of points, which participants could get after completing the testing was 15. Moreover, in all tasks the amount of the repetitions was recorded where it was counted.
The testing tasks and instructions as well as the measuring scale were translated into Finnish in order to make the pre and post-testing process easier for the staff members and the par- ticipants. The translation was done by the author and approved by the Väinölä School and the KUAS. Thus, the translation of the pre and post-testing tasks and measuring scale has should not decreased the reliability of the study.
Grade Explanation
0 Participant was not able to complete the task
1 Participant was able to complete the task with major assistance 2 Participant was able to complete the task with minor assistance 3 Participant was able to complete the task independently without help
